New Test from Standard MRI Could Yield New Insights on Brain Injury

St. Louis, MOWhen Nick Colgin sustained a brain injury while serving in Afghanistan, a standard MRI turned up no discernable injury to his brain. But his symptoms spoke otherwise. For a time, the 26-year-old was unable to write his name, and encountered problems with speech, balance, cognitive thinking and focusing his eyes.

Now, there is emerging evidence that traumatic brain injury stemming from blasts may not be detectable using standard MRI and CT testing.

The New York Times, on June 2, summarized a paper published the day prior in the New England Journal of Medicine revealing that some brain injuries may be too subtle for standard tests, but have since been unearthed using a more concise test via a standard MRI machine.

According to the paper, researchers at Washington University collaborated with their military counterparts at the Landstuhl Medical Center in Germany on diffusion tensor imaging—a process that monitors the flow and movement of water contained in the nerve fibers of the brain.

An abnormal flow may be a representation of brain injury, according to researchers.

Specifically, researchers performed diffusion tensor imaging on 63 military personnel who had sustained mild traumatic brain injury stemming from blasts. Of the 63, eighteen were found to have abnormalities consistent with nerve injury in two or more regions of the brain. While 25 of the subjects had none at all, a further 20 individuals presented with an abnormality in one area of their brain.

The key is that all but one of the 63 test subjects originally presented with a normal result using standard MRI.

It is hoped that the tests, performed in 2008 and 2009, will lead to further research that may result in better helmet design for military personnel at risk for such injury while in the field.

In an aside, it should be noted that according to military protocol, none of the 63 participants were notified as to the results of their tests. ''We were specifically directed by the Department of Defense not to do so,'' said Dr. David L. Brody, an author of the new study and an assistant professor of neurology at Washington University in St. Louis. ''Many of [the test subjects] were hoping we could give results to their care providers to document or validate their concerns. It was anguishing for us, because as a doctor I would like to be able to help them in any way I can. But it was not the protocol we agreed to.''

It is not known if any of the test subjects would be in a position to contact a brain injury lawyer, in an effort to obtain those results for future care. However, in a related story, it was revealed by the Canadian Broadcasting Corporation (CBC) on June 14 that the Canadian military sends soldiers having been diagnosed with post-traumatic stress disorder (PTSD) back into rotation for active duty.

Perhaps, a pending case for brain injury law…